EMDR has received some notable attention recently thanks to its effectiveness in treating trauma. There is a lot of information available online and in academic literature of the therapy, so we put together this article as an overview of EMDR to help you understand what it is and how it works.

So what exactly is EMDR and how does it work?

EMDR stands for Eye Movement Desensitization and Reprocessing, and it involves 8 phases including the use of eye movement, or bilateral stimulation, which appears to be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep. As we wrote about in past blogs, when a person experiences a traumatic event, their brain goes into defense mode and changes its function.

One of these functions includes the hippocampus, which usually works to store memories in a neat filing system that allows us to easily and accurately recall these memories. When faced with a threat, the hippocampus takes on the role of pumping cortisol throughout the body so that we don’t feel pain, and puts the memory storage on the back burner. So it’s no wonder it’s incredibly difficult to recall a traumatic event, or we recall it inaccurately by filling in the blanks later on.

EMDR allows us to go deep into the brain and file these memories with the appropriate meanings and emotions attached to them. According to the EMDR International Association, the goal of EMDR is to:

“Process completely the experiences that are causing problems, and to include new ones that are needed for full health… That means that what is useful to you from an experience will be learned, and stored with appropriate emotions in your brain, and be able to guide you in positive ways in the future. The inappropriate emotions, beliefs, and body sensations will be discarded… The goal of EMDR therapy is to leave you with the emotions, understanding, and perspectives that will lead to healthy and useful behaviors and interactions.”

One of the leading experts on developmental trauma and author of The Body Keeps the Score, Dr. Bessel van der Kolk recalls the experience he had using EMDR on a patient when he realized the power of the therapy. Watch below:

What are the 8 phases of EMDR?

Phase 1: The first phase is a history-taking session(s). The therapist assesses the client’s readiness and develops a treatment plan. Client and therapist identify possible targets for EMDR processing.

Phase 2: During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress. The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions. A goal of EMDR therapy is to produce rapid and effective change while the client maintains equilibrium during and between sessions.

Phases 3-6: In phases three to six, a target is identified and processed using EMDR therapy procedures. These involve the client identifying three things:

In addition, the client identifies a positive belief. The therapist helps the client rate the positive belief as well as the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation. These sets may include eye movements, taps, or tones.

Phase 7: In phase seven, closure, the therapist asks the client to keep a log during the week. The log should document any related material that may arise. It serves to remind the client of the self-calming activities that were mastered in phase two.

Phase 8: The next session begins with phase eight. Phase eight consists of examining the progress made thus far. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses.

From EMDR.com

Does it actually work?

At least 20 positive controlled outcome studies have been done on EMDR therapy. According to the EMDR Institute, which hosts a comprehensive list of EMDR-related research, some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six, 50-minute sessions.

EMDR International Association reports on the same topic, “Clients often report improvement in other associated symptoms such as anxiety. The current treatment guidelines of the American Psychiatric Association and the International Society for Traumatic Stress Studies designate EMDR as an effective treatment for post traumatic stress. EMDR was also found effective by the U.S. Department of Veterans Affairs and Department of Defense, the United Kingdom Department of Health, the Israeli National Council for Mental Health, and many other international health and governmental agencies. Research has also shown that EMDR can be an efficient and rapid treatment” (www.emdria.org).

Who does EMDR?

Only Masters-level or Doctoral-level professionals–therapists, nurses and doctors–who have gone through approved EMDR training can provide EMDR to people. Roots Through Recovery is proud to have two clinicians on our team that are trained and certified to provide EMDR. Clients who have undergone EMDR therapy for trauma have seen great improvement in their management of traumatic experiences, and how that plays a role in their addictions and mental health.

Roots Through Recovery opened its doors in January 2017 and in the last four months, the program has grown to include daytime partial hospitalization and morning intensive outpatient to meet the various needs of our clients. There has been a lot of interest in recent weeks for an evening intensive outpatient program for the working professionals in Long Beach and the South Bay.

In response to this growing need, Roots Through Recovery is excited to announce the start of its evening IOP program beginning the week of May 15th!

CALL NOW (562) 473-0827

Much like our daytime programs, the evening IOP program will focus on addressing underlying trauma and mental health needs of community members who are coping with alcohol or drug addiction. Our compassionate and highly trained therapists provide trauma-informed care in small groups and individual therapy.

Most people who work in recovery or are in recovery themselves, or both, would agree that social connections are important for long-term recovery from addiction. The level of external support individuals have is often referred to as Social Capital or Recovery Capital, which for the purpose of this article, we are defining as:

The abundance of positive social relationships and connections, specifically across the domains of social supports, spirituality, life meaning, and involvement in a recovery community.

Individuals coping with substance use or dependence are often treated as patients with an acute illness, as one would be treated in the ER or urgent care:

Assessment;

Intake;

Treatment; and

Discharge;

which research proves is not an effective approach to achieving sustainable recovery. Alexandre Laudet, PhD., Director of the Center for the Study of Addictions and Recovery (C-STAR) at the National Development and Research Institutes suggests that if one considers addiction to be a chronic condition, a conjecture increasingly accepted in the field, then being in remission (recovery) should be thought about in terms of a long-term process that unfolds over time, rather than a time-limited ‘event’.

The theory of recovery capital suggests that the more abundant our recovery capital, the greater the likelihood we will remain in recovery. We see the value of this connection to community at the very core of sober living environments and groups like Alcoholics Anonymous, an international fellowship of more than 2 million men and women with an alcohol dependence, and their associated groups including Narcotics Anonymous and Cocaine Anonymous. Not surprisingly, we see poorer outcomes and frequent relapse in those who leave treatment, even long-term treatment, without a social network to support them in recovery.

Longitudinal studies, like that of Dr. Laudet’s, exemplify the critical value of social and recovery capital at the various stages of recovery, allowing us to most effectively incorporate these practices into assessment, treatment planning and discharge planning. Whether you’re a staunch supporter of 12-step recovery, a believer in the value of psychotherapy or biomedical treatments, or have embraced the combination of these approaches, it is becoming increasingly more difficult to deny the impact of connections and social support in long-term recovery, both positive and negative.

Taking into consideration the number of connections isn’t enough to determine the impact they will have on an individual in recovery; rather, we must account for the value of each connection, or perceived value. The complex web below shows that our social and peer connections differ in impact based largely on perception. For example, communication can be seen as a sign of caring and concern–a component of emotional support–and therefore, helpful to recovery. In contrast, criticism (a form of communication) may be perceived as unsupportive and therefore harmful to recovery, regardless of intention.

What if having a large, closely-knit social and peer network was detrimental to recovery? The role of social networks and peer support in recovery has been studied for quite some time; and although the research overwhelmingly sways in the direction of the positive impact social networks play in our recovery, a recent NPR article about the increase in opioid abuse in rural communities–in sharp contrast–points to social networks as a main contributor.

The story follows Melissa Morris, whose story of addiction started like many others–with a prescription to Percocet, an opioid pain killer. She got hooked, and when the Percocet stopped getting her high, Morris then started injecting Oxycontin. After that, she got her hands on Fentanyl patches, a highly addictive and potent opioid, and would chew on them instead of applying them to skin as the package directed. When the prescriptions stopped coming, she turned to a cheap and easy option: heroin. Morris’ story is much like what we are seeing across the country, and especially in rural communities.

The facts:

The CDC reports three out of four new heroin users report abusing prescription opioids prior to trying heroin.

In the U.S., heroin-related deaths more than tripled between 2010 and 2015, with 12,989 heroin deaths in 2015.

According to the U.S. Centers for Disease Control and Prevention, opioids were involved in more than 33,000 deaths in 2015 — four times as many opioid-involved deaths as in 2000.

A recent University of Michigan study found the rates of babies born with symptoms of withdrawal from opioids rising much faster in rural areas than urban ones.

So what role do social networks play in the opioid epidemic? The publication about rural Colorado, titled “Rural Colorado’s Opioid Connections Might Hold Clues To Better Treatment”, in addition to limited access to alternative treatments for pain like physical therapy, found in speaking with individuals struggling with opioid addiction that these communities saw an increase in misuse and dependence because rural residents know and interact with roughly double the number of people an average urban resident does. Counterintuitively maybe, this “small town” social network provides members of rural communities twice the number of opportunities to access drugs, according to Kirk Dombrowski, a sociologist at the University of Nebraska-Lincoln.

“So some of those social factors of being in a small town can definitely contribute,” Dombrowski says.

But, like Dr. Laudet’s findings, the Colorado resident Melissa Morris describes how the size of your social network doesn’t define the risk, but rather, the value of the network is often at play. She says that close social ties in her town may have contributed to the spread of opioids there as those bonds can spread drug use quickly, however they can reduce the spread of drugs in other ways. Morris, who is now on Suboxone to help her with her opioid addiction, recently recruited two opioid-dependent friends to the clinic she goes to weekly for treatment.

“I used to sell them pill and heroin,” says Morris, who is now helping these friends get clean. “And so I do have hope. I’ve seen those success stories.”

This consideration of the value, and perceived value, of social networks has great implications for the field of addiction research and treatment. Often times, providers ensure clients broaden their social network and surround themselves with “positive influences”, but as treatment providers, it should be a regular practice to give individuals in recovery the tools needed to regularly take an inventory. We should assess the impact individuals have (are they helpful or harmful?) often as this can frequently change, as our once drug dealers can enter treatment and have a positive impact on our recovery.

What if I told you that there were three (very simple) things you could start doing today that would make you a happier person?

Ex-Google engineer turned mindfulness expert, thought leader, author and philanthropist, Chade-Meng Tan, discovered there really are a couple of things every one of us can start doing each day that will bring joy into our lives, and as a result, make us happier. Meng, as he likes to be called, meditates for hours each day, which the majority of us cannot do… but thankfully, he offers the world the practical application of his education, practice and teaching.

I heard Meng speak on a few podcasts, which I highly recommend if you have the time to check them out: 10% Happier and Note to Self.

I began doing these things as soon as he suggested, because, well, who wouldn’t want to bring more joy, compassion and loving kindness into their daily lives? It works. Meng offers that in order to achieve the depth of cultivation of one’s mind, one must practice like anything else; however, if you have 15 seconds to spare right now, you can improve your outlook, your state of being, and your life.

So here they are, your keys to joy:

1. Bring attention to your breath.

Sounds simple, right? For some people it is, and for others who find it difficult to sit and be present, this can be massive undertaking. Meng says, give yourself 15 seconds for this exercise, 5 seconds per breath.

First breath – Just bring attention to it, be aware of the breath in, and the breath out.

Second breath – Do the same, but this time relax your body, whatever that means for you.

Third breath – Now smile, while you breathe in and out with your body relaxed.

Now, try it. That smile should have brought a subtle sense of joy.

2. Wish happiness to others.

This is the practice of raising the thought to your conscious mind when you see someone of wishing them to be happy. You can do this for people who walk by you on the street, or you can bring the thought of someone in your life and just think to yourself as you picture them, “I wish them happiness”.

You’ll notice that as you do this, being the giver of compassionate loving kindness to others makes you feel this loving kindness yourself.

3. Raise your awareness of the tiny slices of joy already present in your life.

How often do we go our entire day, caught up in our routines and responsibilities, that we forget to appreciate the little things? Too often, is the answer I was looking for.

Our world is filled with what Meng calls “tiny slices of joy”–from taking the first sip of coffee in the morning, the feeling of the hot water from the shower hitting you, laying down in bed and feeling your head sink into the pillow–these wonderful, fleeting moments that we don’t take the time to acknowledge. His belief is that if we allowed ourselves to be present in these moments, we could experience this joy all day long.

Practicing these three simple things each day, experiencing joy and allowing yourself to be present in the moment will inevitably improve your well-being. On why the practice of mindfulness works, Meng says:

To worry you need to be in the future, to regret you need to be in the past. So if you take one breath of being in the present, then for that one breath you are free – you are free from worrying and regret.

And we agree.

***

Chade-Meng Tan (Meng) is a Google pioneer, award-winning engineer, international bestselling author, thought leader and philanthropist. He is Chairman of the Search Inside Yourself Leadership Institute, and Co-chair of One Billion Acts of Peace, which has been nominated eight times for the Nobel Peace Prize.

What Dr. Maté—a leader in addiction medicine and world-renowned author and speaker—is saying, is something we’ve long known to be true about trauma and addiction, and yet the field of addiction treatment still lags behind the research (links to 6 studies at bottom of page): addiction is usually a symptom of underlying trauma, or mental health issues that are the manifestation of trauma. Dr. Maté uses the word ‘pain’ to refer to trauma and other underlying issues, whether it’s past sexual or physical abuse, the pain of not being able to control one’s thoughts and emotions, loss and grief, physical pain or whatever is causing the unpleasant feelings.

In the United States, 61 percent of men and 51 percent of women report exposure to at least one lifetime traumatic event (SAMHSA).

Over two-thirds of people seeking treatment for some sort of addiction report one or more traumatic life events (Back et al., 2000).

Rates of witnessing serious injury or death of others and experiencing physical assault are two to three times higher in substance-using individuals than in the general population (Cottler et al., 2001; Kessler et al., 1995).

So what is trauma?

Trauma becomes increasingly difficult to define in succinct terms as one further investigates and uncovers the myriad definitions. The reason for this is the subjectivity involved in traumatic experiences, which lends itself to the definition that we think is the clearest, from the Substance Abuse and Mental Health Services Administration (SAMHSA):

Individual trauma results from an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.

“Experienced by an individual…” That is the key. Trauma isn’t an event, but how one experiences or perceives an event. This inherent subjectivity is why people can experience the same seemingly traumatic event, such as being in a car accident or growing up in a war-torn country, and come out of the experience with varying degrees of trauma or distress. Trauma can take all forms, from childhood experiences of divorce, abuse and neglect, bullying, and witnessing domestic violence to loss of a parent, loss of employment, a breakup or being involved in a volatile relationship. It can also result from growing up in an alcoholic or addicted home, or any other environment where individuals are taught to bury their feelings.

Roots through Recovery’s Clinical Director, Diana Kang, PsyD. says, “Trauma does not discriminate can can impact anyone. Everyone has a different perception of trauma, and how it is experienced in the body and mind varies greatly from person to person.” Unfortunately, many people experience trauma at some point in their life and don’t understand or acknowledge the trauma, so it goes untreated and manifests itself in fear and hopelessness, depression, anxiety, and in the most severe cases, Post-Traumatic Stress Disorder (PTSD).

The Adverse Childhood Experiences study conducted by Kaiser Permanente and the CDC in the 90s developed a tool for measuring an individual’s exposure to events that could be experienced as traumatic, including abuse or neglect. Some examples of adverse childhood experiences include: physical and emotional abuse or neglect, sexual abuse, witnessing abuse of a parent or another child, substance misuse in the household, divorce of parents and the incarceration of a family member. Although as one reads through the list and these events seem all too common in households we know or our own, ACEs are strongly related to the development and prevalence of a wide range of health problems throughout life, including those associated with substance use and abuse.

ACEs are a good example of the types of complex issues that the prevention workforce often faces. The negative effects of ACEs are felt throughout the nation and can affect people of all backgrounds. Research has demonstrated a strong relationship between ACEs, substance use disorders, and behavioral problems. When children are exposed to chronic stressful events, their neurodevelopment can be disrupted. As a result, the child’s cognitive functioning or ability to cope with negative or disruptive emotions may be impaired.

How does trauma affect my body?

The human body is highly regulated by the stress response systems that have developed over time as a survival mechanism. Experts in the field of stress and trauma, including the brilliant Dr. Nadine Burke Harris, often cite the example of seeing a bear in the forest. In this case, the body instantly responds to the threat by flooding the body with adrenaline, opening up the airways and increasing our heart rate, stifling fear and allowing you to run or fight for survival. This is a great system to have in these situations of life or death. But, what happens when the bear is your dad who comes home drunk at night, or the bully in your school, or an entire block in your neighborhood? Having the body’s fight, flight or freeze response system activated too frequently is damaging to our physiological systems.

Trauma responses act on several systems that affect one’s physiology. According to the Centers for Disease Control and Prevention, what is currently known is that exposure to trauma leads to a cascade of biological changes and stress responses. These biological alterations are highly associated with PTSD, other mental illnesses, and substance use disorders. These include:

“As a clear example, early ACEs such as abuse, neglect, and other traumas affect brain development and increase a person’s vulnerability to encountering interpersonal violence as an adult and to developing chronic diseases and other physical illnesses, mental illnesses, substance-related disorders, and impairment in other life areas” (Centers for Disease Control and Prevention, 2012).

Trauma also affects the brain.

A recent study published by Indian scientists reports new findings on how traumatic experiences affect the brain and how these effects later play out in memories. The study showed heightened electrical activity in the amygdala, located deep within the temporal lobe of the brain. “This region of the brain is known to play key roles in emotional reactions, memory and making decisions. Changes in the amygdala are linked to the development of Post-Traumatic Stress Disorder (PTSD), a mental condition that develops in a delayed fashion after a harrowing experience”. The study also found that a well-known protein involved in learning and memory, NMDA-R, is also involved in the process of creating these unpleasant memories and blocking them during a traumatic event reduced electrical activity at these synapses.

So then how are trauma and substance use connected?

The reasons behind this common co-occurrence of addiction and trauma are complex. For one thing, some people struggling to manage the effects of trauma in their lives may turn to drugs and alcohol to self-medicate. PTSD symptoms like agitation, hypersensitivity to loud noises or sudden movements, depression, social withdrawal and insomnia may seem more manageable through the use of sedating or stimulating drugs depending on the symptom. However, addiction soon becomes another problem in the trauma survivor’s life and before long, their coping mechanism no longer works, and causes far more pain to an already struggling person.

Many people who find themselves in a treatment program aren’t getting the help they need if the program only treats addiction, and does not consider trauma or co-occurring mental health issues (often called “dual diagnosis”) as the root cause of substance use. “Symptoms of someone suffering from trauma include flashbacks, nightmares, feeling like you are reliving the traumatic event, and avoidance of sights, sounds or feelings resembling the traumatic event (i.e. veterans avoiding fireworks during the 4th of July)”, offers Dr. Kang. She goes on to say, “Substance use is often one way to cope and numb out the impact of trauma. Sometimes it may be the only coping method one has. Therefore it is important to treat both the trauma and the addiction. When you address the addiction without looking at the trauma, you are not resolving the root of the addiction.”

With the impact stress responses and trauma have on the body, it’s not surprising that emotional and psychological pain often lead to an endless cycle of self-medicating, which leads to more pain, and inevitably more self-medicating, and so on. Often times, when left undiagnosed and untreated, people will self-medicate with alcohol, illicit drugs or misuse prescription drugs to placate the feelings of depression or anxiety or to numb the pain of the trauma. In these instances, the substances serve a purpose which is why to simply remove the substance, without understanding the individual need for it, is to ignore the cause and is not a long-term solution, much like putting a band aid on a bullet wound. “Over time, and often during adolescence, people with exposure to ACEs may adopt negative coping mechanisms, such as substance use or self-harm, social problems, as well as premature mortality. High ACE scores are associated with substance use disorders in adults:

Early initiation of alcohol use. Underage drinking prevention efforts may not be effective unless ACEs are addressed as a contributing factor. Underage drinking prevention programs may not work as intended unless they help youth recognize and cope with stressors of abuse, household dysfunction, and other adverse experiences. Learn more from a 2006 study on initial alcohol use among adolescents.

Am I at particular risk for trauma and/or addiction?

Other possible reasons addiction and trauma are often found together include the theory that a substance user’s lifestyle puts him/her in harm’s way more often than that of a non-addicted person. Unsavory acquaintances, dangerous neighborhoods, impaired driving, and other aspects commonly associated with drug and alcohol abuse may indeed predispose substance abusers to being traumatized by crime, accidents, violence and abuse. There may also be a genetic component linking people prone toward PTSD and those with addictive tendencies, although no definitive conclusion has been made by research so far.

Often times, clients are not consciously aware that they are using substances to cope with the symptoms of trauma. They may have no memory of a traumatic event or experience, and yet, the trauma surfaces in their body or subconsciously in their brain without them knowing, ands they escape with the use of drugs or alcohol. As Primary Therapist Lauren Emmel said on a recent podcast with Todd Zalkins, “[Trauma] can surface after eight months, four years, ten years. It’s in a part of the brain… that doesn’t know any time. So something that impacted us when we were eight, ten, twelve, can impact us when we’re 20, 30, 40 if left unprocessed.” Self-soothing and distraction are ways people use substances to help get through these challenging times, and in order to develop a lifestyle that does not rely on substances, one must identify new ways to cope with unpleasant feelings.

So what can I do to reduce trauma and its effect on me?

To prevent further harm and prevent relapse, it is up to treatment professionals to recognize the prevalence of trauma among individuals coping with addiction, routinely screen for trauma symptoms, and deliver the integrated, multidisciplinary treatment that has proven effective in treating co-occurring disorders. The Substance Abuse and Mental Health Services Administration offers a helpful manual for practitioners or anyone interested in learning more about trauma informed care in their Treatment Improvement Protocol (TIP) 57, Trauma-Informed Care in Behavioral Health Services.

Treatment for co-occurring disorders, such as Roots through Recovery’s extended care program, offers clients effective ways to work through their trauma and find prosocial and physiologically beneficial ways of addressing the body’s response to trauma. Programs that address trauma from a cognitive, emotional and physiological standpoint allow individuals suffering from trauma and addiction to achieve sustainable life change and support the development of coping skills. Some of the evidence-based practices employed by treatment programs who embrace trauma-informed care are EMDR, Somatic Experiencing, Prolonged Exposure Therapy, Cognitive Processing Therapy, meditation and mindfulness, seeking safety and trauma-focused or mindfulness-based cognitive behavioral therapy.

As we learned, unprocessed trauma can affect us dramatically at the core of our physiology and brain development, have a lasting effect on us psychologically, and can surface at any time. Addressing past trauma is a process, that should take place over time, at the right time and with a professional who is equipped to address trauma.

As primary therapist and EMDR specialist, Lauren Emmel, says, “It’s important to look at the different phases of trauma therapy. In the beginning phase of trauma therapy, if you’re working with recovery, is stabilizing, is creating a safe space, resourcing, going to meetings, finding a support group. The mind is all over the place, so if you start going into the trauma work, it’s going to disregulate the system. So first and foremost, it’s stabilizing. It’s finding a safe space that you feel that you can express yourself. And then the middle part is the actual trauma work.

Avoiding trauma, and turning to unhealthy coping mechanisms, only exacerbates trauma and can lead to addiction or other harmful behaviors. Seeking treatment and confronting trauma in a safe place is the best way to address trauma and reprocess it so that one may give traumatic experiences attention and acknowledgement, but not let them negatively impact your life.

To schedule an intake with an addiction and trauma specialist today, call Roots through Recovery at 562.473.0827 or email info@roots-recovery.com.

Stay informed! You can subscribe to our blog here to get updates straight to your inbox.